Qaashif Panjwani, Mercer University College of Pharmacy
Commonly utilized percutaneous interventions (PCI) are stated to be drug-eluting and bare-metal stents.  A meta-analysis on PCIs indicated no statistical differences among drug-eluting and bare-metal stents in reducing total mortality and proposed a need for long-term follow up to better assess specific safety concerns of the stents. 
|Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease |
|Design||Multicenter, randomized trial; N= 9,013|
|Objective||To determine the rates of death, myocardial infarction (MI), repeat revascularization, and stent thrombosis in long-term use of drug-eluting stents versus bare-metal stents|
|Study Groups||Drug-eluting stent (n= 4,504); bare-metal stent (n= 4,509)|
|Methods||The patients included in the trial were at least 18 years of age and had stable angina, acute coronary syndrome, lesions in native coronary arteries, or coronary-artery grafts. Patients were assigned to each of the respective stents at a 1:1 ratio. All the patients were prescribed aspirin 75 mg daily indefinitely and clopidogrel 75 mg for 9 months. A quality-of-life questionnaire was submitted to the patients at baseline then at 6, 12, 24, 36, 48, and 60 months. The median follow-up was 5 years.|
|Primary Outcome Measure||A composite of death from any cause and nonfatal spontaneous myocardial infarction|
|Adverse Events||Common Adverse Events: N/A|
|Serious Adverse Events: N/A|
|Percentage that Discontinued due to Adverse Events: N/A|
|Study Author Conclusions||There were no statistically significant differences in the 6-year rates of death or spontaneous MI patients receiving drug-eluting stents or bare-metal stents.|
This study is one of the longer follow-up trials examining the long-term efficacy of each of the respective stents. In future studies, it would be beneficial to account for costs associated with adverse events to help decide on a stent. From a clinical standpoint, further evidence would assist in deciding on a stent. Lastly, the Seattle Angina Questionnaire was utilized to collect quality-of-life data, which is not specific for stent performance and as a result causes a loss of generalizability.
- Prasad A, Herrmann J. Myocardial infarction due to percutaneous coronary intervention. N Engl J Med. 2011;364(5):453-64.
- Nordmann AJ, Briel M, Bucher HC. Mortality in randomized controlled trials comparing drug-eluting vs. bare metal stents in coronary artery disease: a meta-analysis. Eur Heart J. 2006;27(23):2784-814.
- Bønaa KH, Mannsverk J, Wiseth R, et al. Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease. N Engl J Med. 2016;